Ординатура / Офтальмология / Английские материалы / Primary Optic Nerve Sheath Meningioma_Jeremic, Pitz_2008
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44 M. F. Mafee and J. H. Naheedy
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Fig. 4.5a–d. Optic nerve sheath presumed meningioma on |
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effacement of the CSF along the left optic nerve compared to |
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the contralateral normal. (From: Mafee MF, Rapoport M, Kari- |
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3T magnet. a Axial T2W. b Enhanced fat suppressed sagittal |
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mi A, Ansari S, Shah J (2005) Orbital and ocular imaging using |
T1W. c Unenhanced fat suppressed axial T1W. d Enhanced fat |
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3- and 1.5-T MR imaging systems. Neuroimag Clin N Am 15:6; |
suppressed axial T1W showing a left optic nerve sheath menin- |
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gioma which is less well depicted on axial MR imaging and best |
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with permission) |
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demonstrated (arrow in b) on enhanced MR imaging.RNote the |
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Fig. 4.6a–d. Optic nerve sheath meningioma on 3T magnet. |
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a Enhanced fat suppressed axial T1W with diffuse enhance- |
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ment of the right optic nerve sheath meningioma. Note the |
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normal left optic nerve (arrow). b Enhanced fat suppressed sa- |
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gittal T1W. c Enhanced fat suppressed coronal T1W showing |
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the meningioma involving the intracranial segment of the right |
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optic nerve (wide arrowhead). Arrows point out the magnetic |
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susceptibility artifact. d Enhanced fat suppressed coronal T1W with the arrowhead depicting the constricted optic nerve surrounded by a optic nerve sheath meningioma. (From: Mafee MF, Rapoport M, Karimi A, Ansari S, Shah J (2005) Orbital and ocular imaging using 3- and 1.5-T MR imaging systems. Neuroimag Clin N Am 15:6; with permission)
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46 M. F. Mafee and J. H. Naheedy
Fig. 4.7. Optic nerve sheath meningioma. Enhanced axial FS |
Fig. 4.8. En plaque meningioma. Enhanced fat suppressed |
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T1W (top) and enhanced sagittal non-fat saturation T1W (bot- |
axial T1W MR image shows en plaque meningioma along the |
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tom) MR images demonstrate left optic nerve sheath menin- |
right optic nerve (arrows) |
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gioma with an exophytic pattern of growth |
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PROOFS |
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Eand histologic evaluation for optic nerve sheath menin- |
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tgiomas (Fig. 4.11). |
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Special Situations |
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Another rare group of meningiomas includes the |
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ectopic, intraorbital, extradural meningiomas. These |
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Intracranial extension of optic nerve sheathRmenin- |
tumors do not appear to have any connection to the op- |
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giomas or intraorbital extension of an intracranialR |
men- |
tic nerve sheath or the optic canal and do not appear to |
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ingioma may easily be demonstrated on either post- |
originate intracranially (Mafee 1992). They arise from |
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contrast CT scans or enhanced T1W MR images. En |
congenitally misplaced nests of ectopic meningothelial |
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cells within the orbital cavity, either in the muscle cone |
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plaque meningiomas of the optic nerve sheath, where |
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or in the walls of the orbit. They are frequently associ- |
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the tumor spreads out along the optic nerve sheath as |
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ated with characteristic, localized expansion of adjacent |
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a thin or slightly thick tumor, can often only be diag- |
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nosed as abnormal enhancement of the optic nerve on |
ethmoid air cells, or so-called “blistering.” |
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enhanced fat suppression T1W MR images (Figs. 4.6 |
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and 4.8). Intracanalicular optic meningiomas usually |
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represent either extensions of posterior orbital tumors or invasion into the optic canal by periforaminal meningiomas arising in the vicinity of the anterior clinoid.
Childhood optic nerve sheath meningiomas are often associated with neurofibromatosis Type 2 (NF2) and are usually more aggressive than the adult form (Fig. 4.9) (Bosch et al. 2006). Children have a higher recurrence rate and a poorer survival rate than adults (Turbin and Pokorny 2004). Bilateral optic nerve sheath meningiomas may occur in patients with or without NF (Fig. 4.10) (Jacobiec et al. 1984). Even neurofibromas, at times, may be mistaken on imaging
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Imaging Diagnosis of the Optic Nerve Sheath Meningioma |
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Fig. 4.9a–f. Optic nerve sheath meningioma. A 12-year-old |
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e Axial enhanced FS T1W MR images showing bilateral vestib- |
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ular schwannomas (arrows). f Coronal CT with arrow pointing |
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male with neurofibromatosis type 2 and a large right optic |
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to right optic nerve sheath calcification. |
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nerve sheath meningioma. a Axial unenhanced T1W. b Axial |
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T2W. c Coronal unenhanced T1W. d Axial enhanced FS T1W. |
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Fig. 4.10. Bilateral en plaque optic nerve sheath meningiomas. Left: Axial enhanced T1W fat suppressed MR showing abnormal enhancement of both optic nerves. Right: Note the abnor-
mal dural enhancement along the chiasmatic sulcus (arrows) and along the anterior clinoids bilaterally (arrowheads)
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Fig. 4.11. Neurofibroma. Unenhanced T1W (left) and enhance |
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cranial nerve V1, helping differentiate it from an optic nerve |
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T1W (right) MR images showing extension of a neurofibroma |
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PROOFS |
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sheath meningioma which would course along the cranial |
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into the cavernous sinus (arrows) along the expected course of |
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nerve II |
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Fig. 4.12a,b. Sarcoidosis. a Axial fat suppressed enhanced T1W. b Coronal enhanced FS T1W MR images. There is diffuse thickening and enhancement of right optic nerve sheath. Note the granuloma involving the ciliary body (arrow) and involvement of the right extra ocular muscles as well
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tendency to present with thickening of the dura and leptomeninges (Weber et al. 1996). Optic nerve sheath sarcoidosis (Fig. 4.12). Lymphoma (Fig. 4.13) and pseudotumor can also be mistaken on imaging for optic nerve sheath meningioma. Optic neuritis may also be mistaken on CT and MRI for optic nerve sheath meningioma. In general, in patients with optic neuritis, contrast enhancement on CT and MR imaging is often
subtle or present in a short segment of the optic nerve, particularly the intracanalicular portion of it. However, at times there may be diffuse unilateral or bilateral optic nerve enhancement mimicking optic nerve sheath meningioma (Fig. 4.14). An en plaque meningioma adjacent to the lesser wing of sphenoid can extend into the optic canal, simulating an intracanalicular optic nerve sheath meningioma (Fig. 4.10) (Charbel et al. 1999).
4.5.1
Optic Nerve Glioma
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Like optic nerve sheath meningioma, MR imaging |
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remains the imaging study of choice for the diagno- |
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sis of optic nerve glioma. The tumor may be solitary |
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(Fig. 4.15) or a component of neurofibromatosis-1 |
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(NF-1). Bilateral optic nerve gliomas are characteristic |
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PROOFS |
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of NF-1 (Charbel et al. 1999). In fact, there is a strong |
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association between optic nerve sheath meningiomas |
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and NF-2 that parallels the well-known association of |
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optic nerve gliomas with NF-1 (Bosch et al. 2006). The |
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Fig. 4.13. Lymphoma of the optic nerve on 3T magnet. Axial enhanced T1W (top) and sagittal enhanced fat suppression T1W (bottom) MR images show normal enhancement of the left optic nerve (arrow) and marked enhancement around the abnormal right optic nerve sheath. Biopsy of the right optic nerve showed lymphomatoid infiltration of the nerve
Fig. 4.14. Bilateral optic neuritis in a patient with rheumatoid arthritis. Axial enhanced fat suppressed T1W MR image shows diffuse enhancement of the optic nerves bilaterally
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Fig. 4.15a–f. Low grade optic glioma on 3T magnet. a Axial T1W. b Axial T2W. c Coronal T2W. d Axial T1W. e Axial enhanced fat suppressed T1W. f Axial enhanced T1W MR images all showing a presumed optic glioma involving the left optic nerve. (From: Mafee MF, Rapoport M, Karimi A, Ansari S, Shah J (2005) Orbital and ocular imaging using 3- and 1.5-T MR imaging systems. Neuroimag Clin N Am 15:7; with permission)
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CT and MRI appearance of optic nerve glioma is often characteristic. The tumor results in marked enlargement along with kinking and buckling of the involved optic nerve (Fig. 4.16, Fig. 4.17). Unlike optic nerve sheath meningioma, cystic changes are commonly seen in optic nerve glioma. At times an optic nerve glioma may not be differentiated on imaging from optic nerve sheath meningioma.
4.6
Miscellaneous
In most cases, the CT and MRI appearance for optic nerve sheath meningioma is quite characteristic. However, at times other rare tumors, such as optic nerve hemangioblastoma, medulloepthelioma, or leptomeningeal carcinomatosis may be mistaken for optic nerve sheath meningiomas. Similarly, a multitude of other orbital tumors can be mistaken for optic nerve sheath meningiomas (Table 4.1), including neurofibroma, schwannoma, fibrous histiocytoma, fibrocytoma, hemangiopericytoma, cavernous hemangioma, lymphangioma, orbital varix, and isolated retrobulbar/optic
nerve metastasis (Mafee et al. 1987; Carmody et al.
1994). Orbital soft tissue chondrosarcoma is anothert rare lesion that due to its tendency for tumoral calcificaC- tion can sometime be mistaken for optic nerveEsheath meningioma (Fig. 4.18a,b) (Shinaver et al. 1997)R .
On MR imaging, abnormal contrast Renhancement of the optic nerve disk and a short segment of the optic nerve just behind the globe hasCObeen described in patients with optic neuropathy asNa result of cat scratch
disease (Schmalfuss et al. 2005). Short-segment retrobulbar involvement, however,u may be seen in multiple sclerosis, sarcoidosis, and other causes of optic neuropathy (Mafee 2005b). When short-segment optic nerve sheath enhancement is discovered on MR imaging, we recommend obtaining unenhanced CT images through the orbit with 1.5 mm thickness for the detection of micro/macro-calcification. None of these conditions mentioned above will demonstrate calcification on CT scanning.
Fig. 4.16. Juvenile pilocytic optic nerve glioma. Sagittal enhanced T1W MR image in a 17-month-old female shows a large mass with intracranial extension to involve the intracranial segment of the optic nerve
Fig. 4.17. Glioblastoma multiforme of the optic nerve. Unenhanced T1W (top) and enhanced T1W with fat saturation (bottom) MR images showing irregular thickening of the right optic nerve (arrowheads). Note diffuse enhancement extending intra-cranially to involve the intraorbital segment of the contralateral nerve (arrows). (Courtesy of A. Flanders, MD, Philadelphia, PA)
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table 4.1. Tumors mimicking optic nerve sheath meningioma
Glioma
Neurofibroma
Schwannoma
Fibrous histiocytoma
Fibrocytoma
Hemangiopericytoma
Cavernous hemangioma
Lymphoma
Lymphangioma
Hemangioblastoma
Medulloepthelioma
Leptomeningeal carcinomatosis
Chondrosarcoma
Solitary retrobulbar/optic nerve metastasis
Orbital varix
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Fig. 4.18. a Orbital mesenchymal chondrosarcoma. T2W (top) and enhanced T1W FS (bottom) MR images show a large heterogeneously enhancing right retrobulbar mass which surrounds the optic nerve. b Orbital mesenchymal chondrosarcoma. Axial unenhanced CT image (top) and axial unenhanced T1W MR image in the same patient from Fig. 4.18A showing large mass with coarse calcifications readily identified on the CT image
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Diego |
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(1982) Sphenoid pneumosinus dilatans. A sign of men- |
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in twenty patients. Rev Neurol (Paris) 163(5):549–559 |
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Hollander MD, Fitzpatrick, O’Connor SG et al. (1999) Optic |
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gliomas: Radiol Clin North Am 25:59–73 |
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guishing MR imaging features from other types of optic |
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and computed tomographic diagnostic of orbital glioma |
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